Development and Implementation of A School-Based Physical Activity Intervention

Abstract

Physical activity enhances opportunities to enjoy a healthy and extended life. Physical inactivity has been identified as a variable which can influence outcomes in all nine of the Australian National Health Priority areas: cardiovascular health, cancer control, injury prevention and control, mental health, diabetes mellitus, asthma, arthritis and musculoskeletal conditions, obesity and dementia. Despite the benefits afforded by regular physical activity, global statistics indicate 60% or more of the world population are not adequately active to attain health benefits. It is reported that approximately only one-third of adolescents internationally are achieving sufficient physical activity to satisfy current guidelines. Amongst younger children, a recent Canadian study indicated that 26% of 5- to13-year-olds did not meet physical activity time recommendations. In Australia, 60% of the population who are 15 years and over are considered to be insufficiently physically active. Research identifying and tracking physical activity patterns has suggested lifestyle physical activity starts early in childhood and is moderately to highly stable throughout the course of life into adulthood. Less active children are more likely to become inactive adolescents and progress to adulthood with the increased likelihood of adverse health outcomes, such as cardiovascular disease. Encouraging children to develop regular physical activity patterns in both childhood and early adolescence provides a platform for habitual physical activity throughout adulthood. The psychosocially based notion of perceived competence, the most specific level of self-esteem, serves as one measurable determinant of whether children go on to be physically active through adolescence and adulthood. Competence motivation theory postulates that children who exhibit high levels of perceived competence in a particular domain are more likely to be motivated to continue engaging with that domain. As a consequence of greater participation in physical activity, children have additional opportunities to develop and refine motor skills and movement competence, leading to potentially even higher levels of perceived physical competence and increased motivation to be active. Because schools are identified as communities that “capture” children for 6 hours per day for nearly 40 weeks of the year and could potentially utilize short timeframes to provide organized and supervised physical activity for children, this research was conducted in a metropolitan primary school in South East Queensland, Australia. This longitudinal study examined the physical activity levels and perceived physical competence of 59 aged 9 and 65 aged 10 primary school children (n=124) who had complete data sets over the 3 years of the study. Physical activity was measured by the Yamax Digiwalker (SW-200) pedometer. Perceived physical competence was measured by the Child and Youth Physical Self- Perception Profile (CY-PSPP). The study had three main aims: to obtain objective, longitudinal data on primary school children’s weekday physical activity levels, to identify differences between girls and boys on physical activity and perceived physical competence, and to ascertain implementation and impact differences in teacher-facilitated school-day physical activity initiatives. An intervention to increase school-day physical activity was implemented in three phases and was shaped in concert with administration, staff and teachers at the school. Upon the conclusion of the intervention, it was intended that it could be self sustaining in the school. Phase 1 involved teachers as facilitators of initiating and leading children in a walking session or other type of physical activity of their choice for 15 minutes daily. Role modeling by teachers, through their own active participation in physical activity sessions, has been positively associated with children’s participation rates. In Phase 2 of the intervention, after consultation with classroom teachers, professional development and additional resources were provided for the teachers. Physical education equipment was also made more easily accessible, with the aim of further supporting facilitation by classroom teachers of physical activity time for students. In Phase 3, fourth-year Bachelor of Education Primary Specialist Health and Physical Education student teachers from a nearby university were recruited to construct and deliver 15-20-minute physical activity circuits for all Grade 4-7 classes on 3 days per week. Circuit activities were required to be developmentally appropriate, inclusive, fun, mostly non-competitive and feasible for a non-specialist trained teacher to deliver. Classroom teachers were provided 24 hours in advance with all lesson plans, diagrams, circuit “mud maps”, station instruction cards for students and station supervision cards for teachers. Teachers were asked to supervise one circuit station on each of the 3 days. During the first phase of the intervention, mean step counts for both boys (12,652 ±3,210) and girls (11,022 ±2,892), respectively, showed small and non-significant decreases from pre-intervention to post-intervention. Boys’ mean daily step counts recorded at each point over the intervention period were always greater than girls’ mean daily step counts. The CY-PSPP data were analysed via parametric tests. Explore tests indicated that normality assumptions were robust and the data was amenable to such analyses. Perceived physical self-esteem measured using the CY-PSPP over this same period showed no significant difference pre/post for any of the six sub-domain scale means for either boys or girls. Differences between girls and boys on means for each of the six scales of the CY-PSPP over this first phase of the intervention were not significantly different. Similar results for physical activity for both boys and girls were recorded from the second phase of the intervention, with mean daily step counts showing small and non-significant decreases across the intervention period. The CY-PSPP was not administered during Phase 2. During the third phase of the intervention, girls’ mean daily step counts (12,349 ±3,468) increased pre to post, however, boys mean daily step counts (13,289 ±3,186) remained relatively stable. Significant differences between the pre- and post- Year 3 CY-PSPP scale means were found for the Sport Competence, Physical Condition, Body Attractiveness and Global Self-Esteem scales. The effect sizes (Cohen’s D) for these differences were moderate to large (0.94, 0.45, 0.33 and 0.38, respectively). For each scale, girls’ self-esteem sub-domain scale means were higher at post-Year 3 than at pre-Year 3. Significant differences between the preand post-Year 3 CYPSPP for boys were found for the Sport Competence, Physical Condition, Physical Self-Worth and Global Self-Esteem. The effect sizes (Cohen’s D) for these differences were moderate to large (0.78, 0.41, 0.47 and 0.34, respectively). During data analyses, both male and female participant groups were split, based on number of mean steps, into tertiles identified as low, middle and high physical activity groups. Low physical activity groups, both girls and boys, reflected the most meaningful changes in daily steps. The low active girls increased steps from pre- to post-measurement in each intervention phase, although none of these were significant. The least active girls took significantly more steps from the inception of the intervention (pre-Year 1) to post-Year 3 (t=2.778, 21; p<.01). The effect size for this increase was large (0.78). The low active boys also took more steps from the beginning to the end of the intervention, and this result approached significance (t=1.922, 17; p<.07). The effect size for this increase was moderate (0.48). Another way of looking at levels of physical activity is by using group categorization of participants to determine whether participants are likely to be meeting the Australian guidelines of 60 minutes per day of moderate-to-vigorous physical activity. All girls and all boys from the low physical activity tertile at the first measurement point in the study had insufficient daily steps to meet Australian guidelines. In Phase 3 of the intervention, girls who were originally in the low active tertile and were classified as insufficiently physically active (n=22), had the greatest conversion rate (56%) to being sufficiently physically active (n=12). These study results suggest that a primary school intervention based upon specialist designed and delivered physical activity curriculum could enable both boys and girls to increase their daily physical activity and perceived physical self-esteem. Analyses of study data also show that children who are more physically active, irrespective of gender, score more highly on all physical self-esteem sub-domains and, thus, have a higher physical self-esteem than those who are less active. For each CY-PSPP subdomain scale and for both genders, children classified as being sufficiently physically activity had higher mean scale scores and were significantly different from the means of those classified as insufficiently physically active. The differences in CY PSPP sub-domain scale mean scores between sufficient physical activity and insufficient physical activity groups had effect sizes ranging from .77 to 1.45. If children with low physical activity levels are a target group for increasing physical activity to prevent chronic health conditions, then it is notable that, amongst all results, the girls and boys with the lowest physical activity levels at the inception of the study showed the most meaningful increases in both mean daily steps and self-esteem scale scores. A school-day physical activity intervention delivered using pedagogical and planning expertise may well be worth the effort for these groups.